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Modified monovision yields better intermediate, distance visual acuity
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Modified pseudophakic monovision resulted in better binocular intermediate and distance visual acuity than conventional monovision, according to a study. However, conventional monovision provided better near visual acuity.
The prospective study included 82 patients who underwent bilateral implantation of a monofocal IOL. At 3 months postoperatively, investigators simulated modified monovision by adding a +0.75 D spherical lens to the nondominant eye or conventional monovision by adding a +1.75 D spherical lens to the nondominant eye.
A non-monovision control group comprised the same 82 patients in whom bilateral eyes were distance corrected without the addition of a spherical lens.
Mean binocular corrected intermediate visual acuity at 1 m was 20/19 and near visual acuity at 0.3 m was 20/51 with modified monovision.
Modified monovision yielded significantly better mean binocular intermediate visual acuity at 1 m than standard monovision (P = .0001).
However, modified monovision resulted in significantly worse near and intermediate visual acuity at 0.5 m (P < .0001).
Modified monovision yielded slightly better mean binocular photopic and mesopic contrast sensitivity and glare visual acuity than standard monovision.
In addition, modified monovision provided markedly better mean stereoacuity than conventional monovision (P = .0020).
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Noel A. Alpins, MD
This well-structured study examines the comparison of simulated monovision to 1.75 D add to modified monovision with 0.75 D uniocular add and anisometropia performed 3 months after monofocal implants were implanted. Near vision was corrected to either 1 m or 0.5 m, respectively, with the aim of better satisfying binocular distance visual acuity as well as adding mid-range near acuities such as a computer and mobile/cell phones.
Predictably, better binocular visual acuity was found with modified monovision for far and intermediate distance, and conventional monovision was found superior for near visual acuity. Contrast visual acuity and stereoacuity were better with modified monovision.
Successful monovision has some dependence on the amount of anisometropia, giving an advantage to modified monovision, and patients also saw better at all near distances (1 m, 0.7 m, 0.3 m) than non-monovision patients. However, with modified monovision, near vision may not be sufficient for reading small letters over a long period of time. Excellent binocular distance to intermediate visions were found in the modified group, without substantial impairment of stereopsis and binocular contrast sensitivity.
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